NPIMap

Organization Active NPI

Pinnacle Health Group PA

  • Internal Medicine Physician
  • Tampa, FL
National Provider Identifier
1023004231
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME71925 Issued in FL
Legal business name
PINNACLE HEALTH GROUP PA
Practice address
2605 W Swann Ave
Ste 100
Tampa, FL 33609-4039
Phone
(813) 874-5500
Fax
(813) 874-5505
NPI assigned
Sep 22, 2005
Last updated
Mar 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sam Diasti, MDNPI 1730175944
Title
President
Phone
(813) 874-5500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X ME71925 FL Primary

Addresses

Primary practice location

2605 W Swann Ave
Ste 100
Tampa, FL 33609-4039

Mailing address

PO Box 18344
Tampa, FL 33679-8344
Phone (813) 874-5500

Other practice location 1

1601 W Reynolds St Ste 201
Plant City, FL 33563-4747
Phone (813) 874-5500

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL TAMPA Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041213000732 FL Part B Supplier - Clinic/Group Practice 6507823440 Receives reassigned benefits from 10 practitioners
Practice locations: Tampa, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0973604Pinnacle Health Group2605 Swann Ave Suite 100, Tampa, FL 33609Certificate of waiverMay 9, 2028

National Provider Directory

National Provider Directory

Locations

2605 W Swann Ave
Ste 100
Tampa, FL 33609
Phone (813) 708-8346

3117 W Gandy Blvd
Tampa, FL 33611
Phone (813) 261-5500

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648684800000",
    "number": "1023004231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18344",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336798344",
            "telephone_number": "813-874-5500",
            "fax_number": "813-874-5505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 W SWANN AVE",
            "address_2": "STE 100",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336094039",
            "telephone_number": "813-874-5500",
            "fax_number": "813-874-5505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1601 W Reynolds St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Plant City",
            "state": "FL",
            "postal_code": "335634747",
            "country_code": "US",
            "telephone_number": "813-874-5500",
            "fax_number": "813-874-5505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PINNACLE HEALTH GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-22",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A",
        "authorized_official_last_name": "DIASTI",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-874-5500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME71925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "TAMPA",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2605 W Swann Ave",
            "address_2": "Ste 100",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336094039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.